- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $7,943.28 / $14,454.40
| Facility | | $2,137.96 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,120.11 / $17,782.79
| Facility | | $6,918.31 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $8,912.51
| Facility | | $1,122.02 | $2,344.23 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,570.40 / $3,548.13
| Professional | | $2,511.89 | $2,570.40 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,495.41 / $8,912.51
| Facility | | $2,754.23 | $5,495.41 | $8,912.51 |